Related Experiment Videos
The Fontan operation in infants less than 2 years of age
H S Weber1, M M Gleason, J L Myers
1Section of Pediatrics (Cardiology), Pennsylvania State University, Milton S. Hershey Medical Center, Hershey 17033.
Insights
Young age is not a risk factor for Fontan operation success. Early Fontan procedures in infants show similar outcomes to older patients, avoiding risks of palliative shunts.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Cardiac Surgery Outcomes
Background:
- Young age is traditionally considered a risk factor for Fontan operation success.
- Improved survival rates in Fontan operations have been observed.
- Palliative shunts can have deleterious effects and may be avoided by early intervention.
Purpose of the Study:
- To evaluate if young age is a risk factor for successful Fontan operation outcomes.
- To compare outcomes of early Fontan procedures in infants versus older children.
- To assess the impact of early Fontan operations on mortality and morbidity.
Main Methods:
- Retrospective study comparing two groups of patients undergoing Fontan operation.
- Group 1: 17 infants (mean age 1.5 years) undergoing early Fontan procedure.
- Group 2: 30 older children (mean age 7.5 years) undergoing Fontan operation. Outcomes analyzed included mortality, arrhythmias, and hospital stay.
Main Results:
- Postoperative mortality rates (early surgical, late, and total) were similar between the early (Group 1) and older (Group 2) Fontan groups (p > 0.05).
- Immediate postoperative arrhythmias were more frequent in Group 1 (71% vs. 25%, p < 0.01) but without mortality.
- Group 1 infants had a longer hospital stay (22 vs. 14 days, p < 0.01).
Conclusions:
- Young age is not a risk factor for successful Fontan operation outcomes in patients with acceptable preoperative hemodynamics.
- An early Fontan operation can be performed safely and effectively, potentially avoiding the complications associated with prolonged palliative procedures.
Abstract:
Young age remains a reported risk factor for a successful Fontan operation despite improved survival rates. Since March 1978, the Fontan operation has been performed in 47 patients. To avoid a primary or secondary palliative shunt, an early Fontan procedure (Group 1: mean age 1.5 +/- 0.5 years, range 0.6 to 2) has been performed in 17 children with the outcome similar to that of the remaining 30 older patients (Group 2: mean age 7.5 +/- 5 years, range 2.4 to 23 years). Preoperatively both groups had acceptable hemodynamic status for a successful Fontan result. Operative variables including cardiopulmonary bypass time, aortic cross-clamp time and core temperature were similar between groups and did not affect mortality. The postoperative mortality rate including early surgical (0% vs. 13%, respectively), late (18% vs. 12%) and total (18% vs. 23%) was similar between Groups 1 and 2 (p greater than 0.05). Immediate postoperative arrhythmias were more frequent in Group 1 (71% vs. 25%, p less than 0.01) with no related mortality, while late arrhythmias occurred with equal frequency (29% vs. 39%, p greater than 0.05). Group 1 infants required a longer hospital stay (22 +/- 9 vs. 14 +/- 5 days, p less than 0.01). Thus, young age is not a risk factor for successful outcome of the Fontan operation in patients with acceptable preoperative hemodynamic status. An early Fontan operation may also avoid prolonged palliative procedures and their potential deleterious effects.